30/04/19, 5 hours general clinic
On the 30th of april I completed 5 hours in the general clinic. My first hour of this five was with a patient that I could see had poor posture from the start. They had protracted shoulders caused by tight pecs and as i thought the patient went on to tell me about how they had been working chest in the gym 2 days prior and felt the tightness in the chest area. I started off with massaged the chest, from medial to lateral sides, always making sure I was running along the lines of the fibres. With the chest you can’t get very deep and also can’t go for too long because as you always have to keep the client happy with towelling obviously the chest area isn’t very big so 10-15 minutes is perfect timing. after the massage I decided to tape the client from anterior deltoid to the opposite lat on both sides in the hope that it would improve the client’s posture and keep them upright for as long as possible and also not allow their shoulders to protract again. Next time I will give the patient aftercare advice about how and when to take the tape off which I didn’t do on this particular occasion.
The next hour was on a patient who came in for pre event massage as they had a game in a few hours. They were a football player so I decided to focus mainly on the lower limb as this would benefit them the most. I started with their calves and went up to quads and hamstrings. On all of these I used effleurage to warm the tissue before moving onto a variety of petrissage techniques such as rolling, wringing and also some tapotment in the form of tapping and hacking, as these are great ways to relax muscle tissue. I also used k tape on this patient as they had slight ankle instability on the lateral side of the left foot. Next time I will take a picture of my work so I can use it as evidence.
The 3rd hour in this session was an hour with another student on my course who was complaining of hamstring tightness. they played at a high level of rugby and with the amount of tension there legs go through in games and training can be very strenuous. They also said they very rarely stretch after games or training which i knew was the reason straight away and advised them to stretch after every single time they partake in exercise. I started the massage with efflaurage to warm the muscle before getting deeper with petrissage techniques e.g wringing, rolling and shaking. I did this on both hamstrings and after this I did an STR on the areas to try and increase their flexibility and strength for game scenarios.
My penultimate hour in the clinic was with a client who came in with no particular areas of tightness or pain so I used them to practise areas I didn’t feel very confident with doing. For example I find crosshatching taping on the knee difficult so I asked the patient if i could possible do this on them to better my techniques and they were fine with it. The taping took about 20 minutes to complete, and overall I was happy with how it went, it looked good/proffesional and the pateint also said they coud feel it stabilizing the knee joint. The remaining 30 minutes where spent doing STR’s on the hamstrings and the pecs. to the the pecs, I applied pressure to the area with my fingers and slowly moved the patients arm in flexion from adduction to abduction and repeated this about 10 times increasing pressure every time. Overall I feel this session was very helpful for me as it has made me more confident at the things I was least confident of before the session.
My final hour in the clinic was spent purely massaging. The client came in with tightness in the back, so firstly I got them to stand up so I could observe. I saw straight away that they had retracting shoulders which indicates tightness in the rhomboid and possibly lat dorsi and so made sense that they came in with this discomfort. I got the client to lay on their front and I began to massage the areas of tightness starting with efflerauge techniques to introduce touch and also get muscles warm in preperation for other techniques like wringing and kneeding. When I introduced petrissage into the massage I made the client put there hand behind there back so I could feel aroud the scapula area and after that was all ok, i then told them to keep the arm in the same position and relax, so I could palpate the rhomboids. Overall I feel as though was my last session went well as I indetified the problem area and massaged them in an effective way to releive at least some tightness.
29/04/19, 4 hours general clinic
On the 29th of April in the general clinic I completed 4 hours. My first hour of the 4 was completed was with a patient who came in with a swollen ankle from a rugby game a week prior to the massage, I didn’t’ know what ligaments were damaged because of the swelling. For this particular client I decided only to use light effleurage in the attempt to move swelling. After this the swelling did seem to reduce but to keep it down after the session I taped the ankle because this could lift the skin tissue off the muscle tissue allowing increased blood flow. Overall I am impressed with myself for this session as i feel as though I reduced the swelling for the patient and because I taped them up I feel as though the stability of their ankle will improve and they will should experience less pain in everyday life.
The second hour of the four was a follow up session with a patient who I massaged on the 12th of april. They came back in this time saying that after the last massage they felt better for the next few days however they also said that they hadn’t been completing more exercise like I told them they should have been doing and that the back had become tight again. I started off by testing their ROM which was poor however nothing I was concerned about just tightness, end feels where all ok. So I massaged them again and started off with effleurage for a bit longer this time as I felt like there could have a lot of trigger points on this patient of wanted to go over them a few times lightly to make sure the pain wasn’t too much. I then attempted to get a bit deeper and try and release the trigger points around the scapula. I feel like I was able to release some which I was happy with however because there was so many I think a two hour session would have been better for this patient because I didn’t really get time to work on anything else however overall happy I could get some trigger points released.
The third hour out of the 4 was with a family member who was in for my final two hours on this day. They told me that felt general tightness, as they went to the gym everyday. I decided as they had a 2 hour slot I would do a full body massage. I started by observing them, palpating any areas of real tightness and testing ROM, there was a lack of ROM when they did shoulder abduction indicating supraspinatus tightness. There isn’t much you can do for this massage wise so i decided to do use some stretching techniques to try and lengthen the muscle, after this I was only left with 20 minutes of the first hour so I massaged there back from the upper traps all the way to their lower erector spinae. In reflection the first hour went well i was happy I tested ROM but could have and will next time give them aftercare advice and more to do at home to improve their supraspinatus ROM.
The second hour with the same patient was purely a leg massage. I did 15 minutes on the calves, 15 minutes on the hamstrings and 15 minutes on the quads. I decided to do this as I knew that at the end I would want to talk to them about aftercare and give them some advise. When I started massage I went the calves first and they felt ok, not very tight and no trigger points so i just used techniques that would allow increased blood flow and loosen the muscles up even more. The hamstrings where different however they were tighter and I got in deeper as a light massage on these muscles as it wouldn’t have done anything. The quads were ok and so I decided to do the same as I did with the calves and not get that deep just repetitive strokes to try and increase blood flow. after I had done 45 minutes on the legs I got the patient to sit down and tell me how I did. they said it was a good massage and there legs felt a bit achy which was a good sign. I told them to continue to recover/stretch every time they go to the gym and partake in exercise because this was the reason for their legs not being tight.
25/04/19
On the 25th of April I completed 3 hours hours in the general clinic. The first hour was was someone who came with tight hamstrings. I palpated and they seemed to have pain in the IT band which I forgot about later on in the massage which was very poor and defiantly the thing I could have done better in this massage because I didn’t take it into consideration and it and it could have definitely been a reason for this client to have tight hamstrings and i’m not even sure that the massage would have benefitted them because of this. I started with effleurage as normal and and got deep into the muscle with petrissage. The client was very tight in the areas and at one point had to ask me to stop as they were in pain so I used friction as I thought it could numb the area and in turn allowing me to get deeper and loosen the muscle as much as possible.
The next patient I had was for 2 hours which was good because i felt as though I could take my time to really observe and palpate the client and try and work out exactly what I wanted to do. They came in complaining of general leg pain which I wasn’t surprised about as they played football at a semi professional level with one game on the weekend and 2 training sessions throughout the week. I started by observing and palpating the client and there was nothing out of the ordinary so i decided to start massaging about 20 minutes. I also had a look at the patient’s gait which was also fine. I massaged their calves, hamstrings and quads with the same intention for all 3, to reduce tightness and increase blood flow. I did this for 30 minutes with 10 minutes of each of the three muscle groups.
After the massage which took up and hour I spent the remaining hour taping and stretching. I taped his quads and hamstrings for stability and increased blood flow. I then moved on to stretching techniques to lengthen muscles in preparation for them to play a lot of football and to high standard. Overall I am happy with how I did in this session as I believe I loosened them and also got them ready to participate in a lot of physical activity at a high standard.
23/04/19
On the 23rd of April I completed 4 hours in the general clinic, 2 massage 1 taping and 1 stretching. The first hour was a general massage on a friend who came in purely to help me gain hours so had no pain in any particular area so I just massaged their back. I started with effleurage to make sure they were ok with the touch, once that was ok I went a bit deeper and managed to find a trigger point and much to there discomfort also managed to get rid of it which was a good feeling. I massaged then for 40 minutes all the way from the small of the back to the upper traps. I feel as though the massage went well however when I found the trigger point I forgot to ask the patient how much pain they were in so probably hurt the client a bit which I cant do next time.
My next hour was a taping session with someone from my course, he had had a bad ankle for a few weeks and had a football game the next day so wanted to be strapped up and have a staple ankle. So for this I decided to use k tape and the figure of 8 motion making sure his foot was in dorsiflexion the whole time to create optimum stability for the client. Whilst I had them in the clinic I decided to use them to practise other rigid tapings on the quad and hamstrings. Overall the hour went well and feel more confident about taping after it.
The third hour in this day was a stretching session with an athlete who was complaining of tight quadriceps, I used MET’s with this client as I felt as though this was the best technique for this specific athlete. The reason being that the results are seen immediately in muscles length and in turn this will make the athlete feel good about me as a practitioner and also that they can be back to full fitness quicker than they thought. I also used STR methods with this client which also seemed to have an immediate effect according to them. Overall I am happy with how the session went however I could have used MET’s more effectively and also I need to brush up on my knowledge of STR’s.
My final hour on this day was with a patient I knew who had discomfort in the lower back region. The patient was a labourer so on a daily basis was lifting heavy objects. I started off by observing the client and they seemed fine however on palpation the erector spinae and lats where very tight and so I decided to massage this patient for 40 minutes starting with effleurage to introduce touch then moving into petrissage, I got deep on this patient as a light massage wouldn’t have made any difference to someone who was as tight as them. Overall this session went well and I got very deep into the muscle tissue which is definitely what this client needed. I also taped the patients back in the attempt to improve their posture.
18/04/19
On the 18th of April I completed 4 hours in general clinic with 4 different clients, the first hour I had a client who was complaining of tight hamstrings, I used deep tissue massage to target the 3 main muscles and relieve some tension, the semitendinosus, semimembranosus and bicep femoris. I also palpated the iliotibial tract, and feel as tho I helped all 4 loosen and helped the patient. Next time I massage I will make sure I wear the correct attire as in this specific session I wore jeans which made it very hard to manoeuvre around the bed.
The second hour on the 18th I had a patient come in with sore quadriceps, it was DOMS. I knew this as 2 days previous the patient had been on a 7 mile run and all the symptoms pointed towards it. I started off lightly to see how the patient dealt with the pressure and it was ok so I moved into deeper tissue massage in the rectus femoris, vastus lateralis and vastus medialis. Next time I will take a better consideration for what the client does and how ever client differs so much I need to adapt my techniques for every individual.
Formative assessment 2
The third hour was my second formative assessment, a few months after the first. This time it was apparent from the start that I had improved dramatically from the last time, from the notes I can see that I improved because; my Plinth height was perfect, my soap notes had improved, bolsters were in perfect positions, and I also used STR’s this time correctly. Overall I was very happy with how this formative Ax went, the patient seemed a lot happier after the massage. I massaged the clients hamstrings and as normal I started with effleurage to introduce touch and then went into petrissage techniques. After the massage and reddening had occurred I started STR by getting them to lie on the bed on their front and placing my hand with pressure on the 3 separate hamstring muscles and slowly let the leg down from flexion to extension. I did this 4-5 times on all 3 muscles.
The fourth was on a patient who came into the clinic wondering why their right knee appeared swollen. To start this hour I had the patient fill out a consultation form and then I observed and palpated. I noticed swelling under the patella and straight away I thought it could have been prepatellar bursitis, It occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the knee. I advised the patient that if the knee started to become painful in any way then they should visit a doctor however I was not concerned as the client was not in any sort of discomfort. For after care advice I advised the client to ice the knee and do as much rest as possible. Next time I would use the game ready machine in the clinic as it would have been perfect to use in this scenario.
12/04/19, 2 hours general clinic
On the 12th of April I completed two hours in the general clinic, the first client was complaining of tightness on his upper back. His job requires long periods of sitting at a desks so I wasn’t surprised when he complained of back pain, I observed and palpated and there was nothing out of the ordinary! I started with effleurage to apply the medium and quickly move into petrissage techniques, I realised I had used to much medium this is something I will look to correct next time. I focused predominantly on upper trapezius and rhomboids. For after care I advised that this client try to complete more exercise throughout the week in order to keep everything moving more often.
The second hour of these two was also with the same patient as the first, so I carried out a longer message for the first time and it last around 1 hour and 30 mins, after this time, the patients was very red showing signs of an affective massage. Next time I would definitely take longer on the observation and palpation to only leave around an hour of massage if I have a patient with a two hour slot.
26/03/19, 2 hours general clinic
On the 26th of March I completed 2 hours in the general clinic. The first hour I had a friend come in who had a football game in 2 days so this session consisted of loosening the muscles and a lot of stretching. The first hour I concentrate prodominantantly on massaging the client’s legs with tapotement to warm muscles up for activity and always used deep tissue techniques so attempt to break any adhesions and increase blood flow to the area. I massaged hamstrings, quads and calves in this massage, mostly with tapotement.
The second hour was with the same client bit this hour I used stretching techniques to increase muscle length and increase joint ROM. This will massively help an athlete prepare for a game and increase the athletes performance. I got the patient in front lying with their knee in flexion, applied pressure to the hamstrings muscles with my hand and slowly lowered the knee into extension. I also taped the patients ankle purely for stability using a figure of 8 technique with k tape. Overall I’m very happy with the preparation for this athlete, I enjoyed getting a player ready for action.
25/03/19, 2 hours open clinic
My fourth open clinic was completed on the 25th of February. My first open clinic hour was also with a third year student and again on the back region however this time it was higher, on the traps and rhomboids. I started by filling out the forms, observing and palpating the client. They helped me out with observation which was good to learn how a third year does it and think it will help me massively with future observations. He has protracted shoulders which would indicate that the shoulders are out of alignment with the spine. He was in the gym the previous day working on this upper back also giving reasons as to why the tightness/discomfort had occurred. I got deep in this message as last time the third year told me to get deeper and I think this helped me produce a better overall massage. Next time I want to be able to observe and make assumptions myself with no help.
The second hour we didn’t have enough clients come into the clinic so we used each other as dummys for taping practice. I started by receiving a taping on my knee which I felt was helpful to see how other people do things and picking up methods and new ways of doing things. I then gave a back taping. I started by making sure the whole area was visible whilst always making sure the client was comfortable. Once it was clear I cut my tape to size and did two long strips from the anterior deltoid all the way to the opposite erector spinae, improving posture. After this we used STR’s on each other’s hamstrings and quads which was very helpful.
21/03/19, 1 hour general clinic
I completed another hour in the general clinic on the same day as my previous open clinic. This hour consisted of a shoulder and neck massage for a patient who had pain in those areas. The patient was a builder who did a lot of heavy lifting throughout the day and therefore has constant strain on their shoulders and neck. When I palpated the areas I noticed a lot of tension and tightness in the upper traps and lats. I started by using effleurage to introduce touch and make sure there is nothing abnormal the patient didn’t know about, when I was happy the patient was fine to be massaged I continued to go into petrissage in the hope of increasing blood flow and breaking the adhesions. In this particular client I found 2-3 trigger points in the traps. I got rid of them by applying pressure to them with a pain out of ten being seven, until the
21/03/19, 2 hours open clinic
My third open clinic was completed on the 21st of March. The first hour I had a friend come in who had a bad shoulder. I started by observing and there was nothing out of the ordinary, I then tested ROM which was poor in shoulder flexion. I knew that the muscles that limit shoulder flexion are pecs, lats and teres major so I massaged him in these areas to try and reduce tightness and increase the blood flow to the area. I also taped around the area to lift the first layer of skin to help blood get to the area. I was happy that I could conclude why their ROM was poor however I’m not sure the tape was necessary so next time I may not tape if it’s a ROM case.
The second hour was a general client who I had never met before who just came in for a leg massage, no pain or discomfort just wanted a massage. I started by observing and palpating to make sure there was nothing the patient didn’t know about themselves. They had no contraindications so I began massage the calves with effleurage to introduce touch and feel for anything they may have not known about and after I was happy there were eligible for a massage I moved on to petrissage techniques. This client wasn’t very tight anywhere in particular so I decided to massage for the whole session just to try and find any adhesions and if nothing else I would have increased blood flow to the areas I massaged. Overall the massage went ok however it was the first time I dealt with someone who had no pain or tightness what so ever so was difficult and at points I found myself wondering what to do next.
11/03/19, 2 hours open clinic
My second open clinic was done on the same day as my previous 2 on the 11th of March. The first hour I had a third year student come in to the clinic who wanted a back massage as they had been in the gym the previous day training this particular area. I started my massaging their erector spinae and it was very tight, I started lightly and got increasingly deeper, I specifically targeted this area because of how tight it was, I started to use my knuckles in the end when redening started to appear I moved up to his traps. Overall it was good to massage a third year as they gave me tips and told me what to do next time and what I did well on this occasion. They said the use of knuckles was very good however I should have got deeper into the tissue sooner.
The second hour of open clinic there wasn’t enough clients who came in so I had to share a client who was complaining of tight hips. Me and the other student had to observe the patient, we realised they had an anteriorly tilted pelvis which would indicate long periods of sitting which makes sense seeing as though the patient worked in an office. We then had to towel the patient properly and make sure they felt comfortable, once this had been achieved we started massaging the TFL and the patient was in discomfort so we decided to do some STR and stretching techniques which seemed to help according to the client. It was hard to share a client because it didn’t feel personal however in the circumstances I think we both did well.
11/03/19, 2 hours
Another 2 hours were done on the 11th of March in the general clinic. The first hour I had a patient who came in with no particular areas of pain but was an active person who ran long distances 3 times a week so wanted a general leg massage. As there was no particular area of pain I decided in best not to observate and just ask the patient contraindications and get on with the massage. I started with their gastroc and soleus, there were tight but no abnormalities apart from that. I massaged their calves, hamstrings and quads with all the same techniques, starting off with effleurage and ending with petrissage. I did 15 minutes on each, feeling like I managed my time well in this particular hour.
The second hour I had a client come in with pain in the hamstrings. I decided to measure there ROM and realised that they had limitations in hip flexion and knee flexion. I was expecting this with hamstring pain. I started off with massage to try and increase blood flow and reduce tightness, then quickly turned to STR as I thought this would be best to help the patient. Overall I probably shouldn’t have spent so much time massaging and more time doing STR’s and stretching techniques as this benefited the client more.
Open clinic 12/02/19, 2 hours
On the 12th February I completed my first 2 hours in the open clinic. My first hour in the open clinic was on a patient who came in with shoulder pain, I started by observing and palpating the patient, I noticed the left shoulder was higher than the other indicating tightness in the upper traps, I concentrated on the left upper trap for the majority of the session. I did some STR on neck and also attempted to find points of tension around the scapula. Overall it was a good hour and I learned a lot, next time I won’t spend as long on one specific area.
The next hour in the open clinic was a taping hour, I taped a patient who didn’t have any particular area of pain or discomfort this was more for me to practise my taping. I did 4 taping on this patient the first one being on the shoulder, I started (as I did with all 4) by making sure the area of treatment was clean and ready to be taped on. Once that was ok I cut the pieces of tape to length and began sticking them on the patient. The second taping was done on the knee in a simple, under the patella arching round to the vastus lateralis and the vastus medialis. The third tape was put on the calf, with one piece going from the plantar fascia, up to the top of the gastrocnemius, and the final one was on the sole of the foot with one piece of tape going from on end the of the to the other horizontally and the other vertically from side to side. Overall happy with the tapings however there is definitely room for improvement.
07/02/19, 1 hour
Formative assessment 1
On the 7th of February, I completed another hour in the general clinic. This hour was my first formative assessment sheet completed, it went well overall however there were a few mistakes made that I will change next time such as, plinth height and making sure I complete a postural assessment. After making sure washed my hands and the bed was clean I then asked if the patient had any particular area of pain or discomfort, to which they said they didn’t’ but they wanted a back massage. I started to massage them with effleurage techniques to introduce touch and see if there was any unknown contradictions, when i found out there wasn’t I next used petrissage techniques to get deeper into the muscles and attempt to break any adhesions and increase blood flow. I didn’t find any trigger points on this patient which is a good thing. Next time I massage I will make sure I change plinth height to patient needs and complete a postural assessment on a patient and also revise my STR methods.
11/01/19, 1 hour
On the 11th of January 2019 I completed one hour in the general clinic on a client who was complaining of right hamstring tightness. I started by observing the patient’s legs and palpating the area. There was nothing out of the ordinary apart from a bit of tightness. I started with effleurage to introduce touch and then moved into petrissage to break any potential adhesions and increase blood flow. Next time I will work around other structures above and below to see if it was any of them causing the tightness.
13/12/18, 2 hours
On the 13/12/18 I completed my 12th and 13th hours in the clinic, the first client came in complaining on hip pain, this was my first hip pain patient so was a bit in the dark as to the correct way to approach massage in this instance. I started by towelling the patient so I could only see there right hip and they said they felt comfortable so I was happy, I palpated there TFL and proceeded to give them a deep tissue massage over the area. Next time I will be more confident with my towelling techniques.
The 13th hour was a new patient who came in with shoulder pain so firstly I asked them to take there t shirt off so I could observe and palpate, this patient had one shoulder higher than the other which could suggest tight trapz. I completed (for the first time) some tests on the patient to which all the results were negative so I concluded it was just DOMS and started a deep tissue massage on the shoulders. Next time I wonder concentrate on the specific areas rather than just the whole shoulder region.
07/11/18, 2 hours
My 10th and 11th hours were also completed in the clinic on the 07/11/18. The first patient was complaining of lower back pain so first I got them to stand up so I could observe the way they were standing, they had a slightly anteriorly tilted pelvis and protracted shoulders. I next made them do some movements to eliminate or show possible reasons for the pain, the tests were all negative so I concluded that it must have just been tightness. For this patient I only managed to give myself around 15-20 minutes to actually massage them. Next time I will manage my time better.
For the 11th hour I had a different patient who just had tight gastrocnemius on both legs, this could be because they partake in a lot of physical activity. They do football on a Monday, Wednesday and Saturday and do not warm up and cool down, I started with effleurage and went into petrissage techniques such as rolling, wringing and getting my elbow in to attempt to loosen the muscles, next time I will get deeper into the tissue as I feel as good though the patient was always to comfortable and I didn’t get deep enough.
05/11/18, 1 hour
My next hour was done on 05/11/18 in the general clinic. This patient didn’t have any pain in a particular area they were just a bit tight in their legs. I started off with some effleurage techniques on the patients gastrocnemius and after this I went into petrissage techniques like rolling, wringing and lifting. I did these techniques on their calfs, hamstrings and quads. Next time I will try to identify where the tightest parts of the patient were and target them instead of doing everywhere evenly.
24/10/18, 3 hours
My next 2 hours were completed in the general clinic on the 24/10/18 when I had two clients come in. Both of them had the same problem with very tight gastrocnemius on their right legs, so for the first 10 minutes i concentrated solely on palpating/observing them to work out why and where was tight. I suspected that it was their running style and the fact he didn’t stretch anywhere near enough that caused the tightness as they play rugby 3 times a week and don’t cool down after sessions/games. I firstly used the effleurage technique to introduce touch and make sure there was no contraindications they weren’t aware of. I then used petrissage techniques including rolling and wringing. On reflection I think I did well to identify why the tightness was occurring however next time I think I could have definitely got deeper with my techniques I think this was down to this being one of my first session and not being overly confident.
My next hour was completed on the same day as the previous 2, this time the client was complaining of hamstring tightness in both legs. This client didn’t partake in regular exercise and worked in a office so i assumed straight away that they never stretch which they didn’t. I couldn’t do a deep tissue massage on the client as it was too painful for them so I did light effleurage and petrissage. On reflection I could have used MET’s on this patient to try and lengthen their muscles and normalise the joint.
07/10/18, 5 hours
My first hours were completed on 07/10/18. I did 5 hours at the plymouth 10k. We were set up in the guild hall. Overall it was a very good experience and definitely improved my confidence in massage. Me and another person on the course shared a bed so when patients came we did a leg each, 90% of the people coming through wanted massages on their hamstrings and gastrocnemius, we started with effleurage to confirm initial contact just to check there was no major underlying issues. Luckily all of our patients on that day were fine just tight as they had just partaken in a 10k run. If i could go back and do it again I would have had more conversation with the patients to try and gain a better understanding of what they wanted and how it felt, I was also to unconfident on that day to give them a real deep tissue massage which they probably needed. One women came in complaining of lower back pain. I started off with effleurage technique to try and identify where the pain was coming from, I should have asked her to stand up so I could observe her posture. It was my first few hours and I didnt know enough to feel where or why her pain was occurring.